Make cities fit for life

The link between the urban realm and people’s health is real. What can you do about it?

The way our towns and cities are designed and planned affects our health: the way we move and interact with the city can help or hinder both formal and incidental exercise. Yet evidence suggests councils and developers stress such issues less than you might think. 

The modern planning system was born out of a need to manage public health. Yet for decades the two systems have sat separately, responsible  to different bodies – the NHS and local government – and to two government departments. So it’s not surprising such common sense is not applied on the ground. In 2013 responsibility for the two came together and local authorities will now make decisions that will improve life expectancy and reduce health inequalities. 

One reason why such demands might not be made on new developments could be a lack of tangible evidence. This month, a RIBA report examines health data and compares three serious health problems – diabetes, obesity in children and physical inactivity – in England’s nine most populated cities. We found a clear link between land use and health outcomes in those cities. The healthiest local authorities in our major cities have almost half the housing density and a fifth more green space than the least healthy ones.


The areas in our cities in which the fewest people exercise have twice the housing density and 20% less green space than those with the most active populations

Physical activity

Across England, 11.2% of adults report levels of exercise that meet the recommended minimum equivalent of 30 minutes of moderate exercise for five days a week. In three out of nine cities the percentage of physically active adults was lower than the national average. 

The areas in our cities in which the fewest people exercise have twice the housing density and 20% less green space than those with the most active populations.

Diabetes in adults

Across England 5.5% of adults are registered as diabetic. Comparing the prevalence of dia­betic adults, the least healthy areas in our cities have twice the housing density and 25% less green space than the most healthy.


Obesity in children

Across England 19% of children are obese. In five out of nine cities the percentage of obese children was higher than the national average. Comparing the prevalence of obese children, the least healthy parts of our cities have twice the housing density and nearly a third less green space than the most healthy. 

This indicates a strong correlation bet­ween obesity and the amount of green space/housing density, even when accounting for deprivation. But if that is the situation in our major cities, what will make the difference? Could design solutions really help?

We asked residents in those nine cities what they thought. Our survey, undertaken by YouGov, asked them how much exercise they took each week and what they thought would increase the amount of brisk walking they do. Across the nine cities 59% of people did too little: 75% of those could be convinced to walk more each week while 25% of all respondents said nothing would encourage them to walk more each week. Interestingly, the most common change that people said would encourage them to walk more was designing streets and parks to be safer and more attractive. This was more popular even than more direct routes to key destinations and an increase in the number of streets and parks.

People say quality, not quantity, of streets and parks will encourage them to walk more. 

This is something that government and local authorities should be taking seriously. If 75% of people failing to exercise enough across the county did meet recommended levels of walking, £675m a year could be saved. If we design places that people want to use we can lay the foundations for regular physical activity – so reducing obesity, related health problems, and their public cost.


What will make the difference?

Healthy design needs to be enshrined in planning guidance. Each local authority should produce a Healthy Infrastructure ­Action Plan outlining their strategy for making streets and parks safer and more attractive, and the principles new developments must meet in order to gain planning perm­ission.

The Community Infrastructure Levy (CIL) is an opportunity for local authorities to make new developments deliver value in their communities. It should be used to enhance both safe and attractive streets shared by new and old communities, and the quality of local parks and shared green spaces.  

Redirected funding could improve health equalities. Local authorities have ring fenced grants to spend on public health services, which have increased by an average of 5%. However, while the 10 city authorities with the worst health performance were promised 10% extra each year, seven of them have still not received the money. They should be prioritised in the next round of grants and spend the money on actions specified in their Health Infrastructure Investment Plan (HIIP).

Developers should prove how their new scheme will benefit public health through their design of the public realm and its links to existing infrastructure. This should be submitted as part of the design and access statement when they apply for planning, and address how it complies with the HIIP.

As architects we need to demonstrate to our clients the need for design measures to encourage walking and use of the public realm. The challenge is with you. 


Anna Scott-Marshall is head of external affairs at the RIBA.